Summary
Background
Adults with SARS-CoV-2 infection have shown higher risks of dyslipidaemia and abnormal body mass index (BMI). Whether similar associations exist in children and adolescents is unclear.
Method
We did a retrospective cohort study using the RECOVER paediatric Electronic Health Record (EHR) datasets from 25 US children’s hospitals, covering March 2020 to September 2023. For dyslipidaemia analyses, we included 384,289 patients aged 0–21 years with at least 6 months of follow-up and 1,080,413 COVID-19-negative controls. For BMI analyses, we included 285,559 patients aged 2–21 years and 817,315 controls. Documented infection was defined as a positive PCR, serology, or antigen test, or a clinical diagnosis of COVID-19 or post-acute sequelae of SARS-CoV-2. Outcomes were new diagnoses of dyslipidaemia, defined by laboratory thresholds for total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, and non-HDL cholesterol, and abnormal BMI (BMI-for-age ≥95th percentile at ages 2–19 years or BMI ≥30 kg/m² at ages 19–21 years). Adjusted relative risks (aRRs) were estimated using propensity score-stratified Poisson regression. Sensitivity analyses included empirical calibration with negative control outcomes and stratification by baseline obesity.
Interpretation
Children and adolescents with documented COVID-19 were associated with higher risks of new-onset dyslipidaemia and abnormal BMI in the post-acute period compared with COVID-19-negative peers. Associations were consistent across lipid fractions, remained after empirical calibration, and were similar after accounting for baseline obesity.
Research in context
Evidence before this study
Adults with SARS-CoV-2 infection have been reported to develop dyslipidaemia and abnormal body mass index (BMI) after the acute phase, raising concerns about long-term metabolic health. In children and adolescents, evidence has been scarce. Available studies are small, cross-sectional, or based mainly on diagnosis codes, with few incorporating laboratory lipid values or age-specific BMI thresholds against contemporaneous controls. The risk of post-acute dyslipidaemia and BMI abnormalities in paediatric populations therefore remains uncertain.
Added value of this study
Using the Researching COVID to Enhance Recovery (RECOVER) electronic health record (EHR) database from 25 US hospitals, we examined more than 1.6 million children and adolescents with at least 6 months of follow-up. Outcomes were defined using laboratory lipid panels and age-specific BMI measures. With propensity score stratification across hundreds of covariates and calibration using negative control outcomes, documented COVID-19 was associated with higher adjusted risks of abnormal HDL cholesterol, LDL cholesterol, total cholesterol, triglycerides, and BMI. Associations were consistent across sensitivity analyses and stratified by baseline obesity.
Implications of all the available evidence
Together with findings from adult studies, our results indicate that metabolic sequelae after SARS-CoV-2 infection are also relevant in paediatric populations. Children and adolescents with documented COVID-19 were more likely to develop dyslipidaemia and abnormal BMI in the early post-acute phase. These findings support routine lipid and BMI monitoring in paediatric follow-up care, which could enable earlier identification of metabolic dysfunction and guide preventive strategies for long-term cardiometabolic health.
Full Text
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